S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5723

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              March 6, 2013
                               ___________

Introduced  by M. of A. HEASTIE -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  the  purchase  of
  prescription drugs

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 28 of subsection  (i)  of  section  3216  of  the
insurance  law, as amended by chapter 11 of the laws of 2012, is amended
to read as follows:
  (28) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY  PHARMACY  BENEFIT
MANAGER UNDER CONTRACT TO A HEALTH PLAN OR UNDER THE CONTROL OF A HEALTH
PLAN  SHALL UTILIZE THE SAME BENCHMARK INDEX, INCLUDING THE SAME AVERAGE
WHOLESALE PRICE, MAXIMUM ALLOWABLE COST AND NATIONAL  PRESCRIPTION  DRUG
CODES  TO  REIMBURSE  ALL PHARMACIES PARTICIPATING IN THE HEALTH BENEFIT
PLAN REGARDLESS OF WHETHER A PHARMACY IS A  MAIL  ORDER  PHARMACY  OR  A
COMMUNITY  PHARMACY.  FURTHERMORE,  THE  PHARMACY  BENEFIT MANAGER SHALL
EXPRESSLY DISCLOSE TO THE HEALTH PLAN SPONSOR IN  THE  CONTRACT  IF  THE
PHARMACY  BENEFIT  MANAGER  RETAINS  ALL  OR A GREATER PORTION OF A DRUG
MANUFACTURER'S REBATE AMOUNT OR ANY ADDITIONAL DIRECT OR INDIRECT REMUN-
ERATION FROM ANY THIRD PARTY, FOR DRUGS DISPENSED THROUGH  THE  PHARMACY
BENEFIT MANAGER OWNED MAIL ORDER PHARMACY THAN THOSE DISPENSED THROUGH A
RETAIL PHARMACY.
  (2)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
PROVIDES  ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER THAN
FACE-TO-FACE.
  (B) Any policy that provides coverage  for  prescription  drugs  shall
permit  each  insured  to  fill  any  covered  prescription  that may be

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09462-01-3
              

A. 5723                             2

obtained at a network participating mail order or other non-retail phar-
macy, at the insured's option, at a network participating non-mail order
retail pharmacy provided that the network participating  non-mail  order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms  and conditions,] that the insurer has established for the network
participating mail order or other non-retail pharmacy. In such  a  case,
the  policy  shall not impose a co-payment fee or other condition on any
insured who elects to purchase prescription drugs from a network partic-
ipating non-mail order retail pharmacy which  is  not  also  imposed  on
insureds  electing  to  purchase drugs from a network participating mail
order or other non-retail pharmacy.
  S 2. Paragraph 18 of subsection (1) of section 3221 of  the  insurance
law, as amended by chapter 11 of the laws of 2012, is amended to read as
follows:
  (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1)  "SAME  REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY PHARMACY BENEFIT
MANAGER UNDER CONTRACT TO A HEALTH PLAN OR UNDER THE CONTROL OF A HEALTH
PLAN SHALL UTILIZE THE SAME BENCHMARK INDEX, INCLUDING THE SAME  AVERAGE
WHOLESALE  PRICE,  MAXIMUM ALLOWABLE COST AND NATIONAL PRESCRIPTION DRUG
CODES TO REIMBURSE ALL PHARMACIES PARTICIPATING IN  THE  HEALTH  BENEFIT
PLAN  REGARDLESS  OF  WHETHER  A  PHARMACY IS A MAIL ORDER PHARMACY OR A
COMMUNITY PHARMACY. FURTHERMORE,  THE  PHARMACY  BENEFIT  MANAGER  SHALL
EXPRESSLY  DISCLOSE  TO  THE  HEALTH PLAN SPONSOR IN THE CONTRACT IF THE
PHARMACY BENEFIT MANAGER RETAINS ALL OR A  GREATER  PORTION  OF  A  DRUG
MANUFACTURER'S REBATE AMOUNT OR ANY ADDITIONAL DIRECT OR INDIRECT REMUN-
ERATION  FROM  ANY THIRD PARTY, FOR DRUGS DISPENSED THROUGH THE PHARMACY
BENEFIT MANAGER OWNED MAIL ORDER PHARMACY THAN THOSE DISPENSED THROUGH A
RETAIL PHARMACY.
  (2) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY  BUSINESS  IS
TO   RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER  THAN
FACE-TO-FACE.
  (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides  cover-
age for prescription drugs shall permit each insured to fill any covered
prescription  that may be obtained at a network participating mail order
or other non-retail pharmacy, at the  insured's  option,  at  a  network
participating  non-mail  order retail pharmacy provided that the network
participating non-mail order retail pharmacy agrees [in advance, through
a contractual network agreement,] to the same reimbursement amount[,  as
well  as the same applicable terms and conditions,] that the insurer has
established for the network participating mail order or other non-retail
pharmacy. In such a case, the policy shall not impose a  co-payment  fee
or  other  condition  on any insured who elects to purchase drugs from a
network participating non-mail order retail pharmacy which is  not  also
imposed  on  insureds  electing to purchase drugs from a network partic-
ipating mail order or other non-retail pharmacy; provided, however, that
the provisions of this section  shall  not  supersede  the  terms  of  a
collective  bargaining agreement or apply to a policy that is the result
of a collective bargaining agreement between an employer  and  a  recog-
nized or certified employee organization.
  S  3. Subsection (hh) of section 4303 of the insurance law, as amended
by chapter 11 of the laws of 2012, is amended to read as follows:

A. 5723                             3

  (hh) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
  (A)  "SAME  REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY PHARMACY BENEFIT
MANAGER UNDER CONTRACT TO A HEALTH PLAN OR UNDER THE CONTROL OF A HEALTH
PLAN SHALL UTILIZE THE SAME BENCHMARK INDEX, INCLUDING THE SAME  AVERAGE
WHOLESALE  PRICE,  MAXIMUM ALLOWABLE COST AND NATIONAL PRESCRIPTION DRUG
CODES TO REIMBURSE ALL PHARMACIES PARTICIPATING IN  THE  HEALTH  BENEFIT
PLAN  REGARDLESS  OF  WHETHER  A  PHARMACY IS A MAIL ORDER PHARMACY OR A
COMMUNITY PHARMACY. FURTHERMORE,  THE  PHARMACY  BENEFIT  MANAGER  SHALL
EXPRESSLY  DISCLOSE  TO  THE  HEALTH PLAN SPONSOR IN THE CONTRACT IF THE
PHARMACY BENEFIT MANAGER RETAINS ALL OR A  GREATER  PORTION  OF  A  DRUG
MANUFACTURER'S REBATE AMOUNT OR ANY ADDITIONAL DIRECT OR INDIRECT REMUN-
ERATION  FROM  ANY THIRD PARTY, FOR DRUGS DISPENSED THROUGH THE PHARMACY
BENEFIT MANAGER OWNED MAIL ORDER PHARMACY THAN THOSE DISPENSED THROUGH A
RETAIL PHARMACY.
  (B) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY  BUSINESS  IS
TO   RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER  THAN
FACE-TO-FACE.
  (2)  Any contract issued by a medical expense indemnity corporation, a
hospital service corporation  or  a  health  services  corporation  that
provides  coverage  for  prescription  drugs  shall  permit each covered
person to fill any covered  prescription  that  may  be  obtained  at  a
network  participating  mail  order or other non-retail pharmacy, at the
covered person's option,  at  a  network  participating  non-mail  order
retail  pharmacy  provided that the network participating non-mail order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms and conditions,] that the  corporation  has  established  for  the
network  participating mail order or other non-retail pharmacy.  In such
a case, the contract shall not impose a copayment fee or other condition
on any covered person who  elects  to  purchase  drugs  from  a  network
participating  non-mail  order retail pharmacy which is not also imposed
on covered persons electing to purchase drugs from a network participat-
ing mail order or other non-retail pharmacy; provided, however, that the
provisions of this section shall not supersede the terms of a collective
bargaining agreement or apply to a contract that  is  the  result  of  a
collective  bargaining agreement between an employer and a recognized or
certified employee organization.
  S 4. This act shall take effect immediately.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5723--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              March 6, 2013
                               ___________

Introduced  by M. of A. HEASTIE, BRINDISI, RAIA, KEARNS, COLTON, PAULIN,
  ABINANTI, PERRY, MALLIOTAKIS, CYMBROWITZ, RODRIGUEZ,  HEVESI,  LAVINE,
  MOYA,  ROSENTHAL,  THIELE  --  Multi-Sponsored  by -- M. of A. ARROYO,
  GIGLIO, RA, ROZIC -- read once and referred to the Committee on Insur-
  ance -- committee  discharged,  bill  amended,  ordered  reprinted  as
  amended and recommitted to said committee

AN  ACT  to  amend  the  insurance  law,  in relation to the purchase of
  prescription drugs

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  28  of  subsection  (i) of section 3216 of the
insurance law, as amended by chapter 11 of the laws of 2012, is  amended
to read as follows:
  (28) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER  SUBPARAGRAPH  (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE,  MAXIMUM  ALLOW-
ABLE  COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
CIES PARTICIPATING IN THE INSURANCE  NETWORK  REGARDLESS  OF  WHETHER  A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (2)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
PROVIDES  ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER THAN
FACE-TO-FACE.
  (B) Any policy that provides coverage  for  prescription  drugs  shall
permit  each  insured  to  fill  any  covered  prescription  that may be
obtained at a network participating mail order or other non-retail phar-
macy, at the insured's option, at a network participating non-mail order
retail pharmacy provided that the network participating  non-mail  order

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09462-04-3
              

A. 5723--A                          2

retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms  and conditions,] that the insurer has established for the network
participating  mail  order or other non-retail pharmacy. In such a case,
the policy shall not impose a co-payment fee or other condition  on  any
insured who elects to purchase prescription drugs from a network partic-
ipating  non-mail  order  retail  pharmacy  which is not also imposed on
insureds electing to purchase drugs from a  network  participating  mail
order or other non-retail pharmacy.
  S  2.  Paragraph 18 of subsection (1) of section 3221 of the insurance
law, as amended by chapter 11 of the laws of 2012, is amended to read as
follows:
  (18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
  (1) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL PROVIDE THE  SAME  BENCH-
MARK  INDEX,  INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOW-
ABLE COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL  PHARMA-
CIES  PARTICIPATING  IN  THE  INSURANCE  NETWORK REGARDLESS OF WHETHER A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (2) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY  BUSINESS  IS
TO   RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH  ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH  THE  USE  OF
THE  UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER  THAN
FACE-TO-FACE.
  (B)  Any  insurer  delivering  a  group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides  cover-
age for prescription drugs shall permit each insured to fill any covered
prescription  that may be obtained at a network participating mail order
or other non-retail pharmacy, at the  insured's  option,  at  a  network
participating  non-mail  order retail pharmacy provided that the network
participating non-mail order retail pharmacy agrees [in advance, through
a contractual network agreement,] to the same reimbursement amount[,  as
well  as the same applicable terms and conditions,] that the insurer has
established for the network participating mail order or other non-retail
pharmacy. In such a case, the policy shall not impose a  co-payment  fee
or  other  condition  on any insured who elects to purchase drugs from a
network participating non-mail order retail pharmacy which is  not  also
imposed  on  insureds  electing to purchase drugs from a network partic-
ipating mail order or other non-retail pharmacy; provided, however, that
the provisions of this section  shall  not  supersede  the  terms  of  a
collective  bargaining agreement or apply to a policy that is the result
of a collective bargaining agreement between an employer  and  a  recog-
nized or certified employee organization.
  S  3. Subsection (hh) of section 4303 of the insurance law, as amended
by chapter 11 of the laws of 2012, is amended to read as follows:
  (hh) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
  (A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER PARAGRAPH TWO OF THIS SUBSECTION SHALL PROVIDE THE SAME  BENCHMARK
INDEX,  INCLUDING  THE  SAME  AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
COST AND NATIONAL PRESCRIPTION DRUG CODES TO  REIMBURSE  ALL  PHARMACIES
PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
  (B)  "MAIL  ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO  RECEIVE  PRESCRIPTIONS  BY  MAIL,  TELEFAX  OR  THROUGH   ELECTRONIC
SUBMISSIONS  AND  TO  DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF

A. 5723--A                          3

THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES  AND
PROVIDES  ANY  CONSULTATION  WITH  PATIENTS  ELECTRONICALLY  RATHER THAN
FACE-TO-FACE.
  (2)  Any contract issued by a medical expense indemnity corporation, a
hospital service corporation  or  a  health  services  corporation  that
provides  coverage  for  prescription  drugs  shall  permit each covered
person to fill any covered  prescription  that  may  be  obtained  at  a
network  participating  mail  order or other non-retail pharmacy, at the
covered person's option,  at  a  network  participating  non-mail  order
retail  pharmacy  provided that the network participating non-mail order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms and conditions,] that the  corporation  has  established  for  the
network  participating mail order or other non-retail pharmacy.  In such
a case, the contract shall not impose a copayment fee or other condition
on any covered person who  elects  to  purchase  drugs  from  a  network
participating  non-mail  order retail pharmacy which is not also imposed
on covered persons electing to purchase drugs from a network participat-
ing mail order or other non-retail pharmacy; provided, however, that the
provisions of this section shall not supersede the terms of a collective
bargaining agreement or apply to a contract that  is  the  result  of  a
collective  bargaining agreement between an employer and a recognized or
certified employee organization.
  S 4. This act shall take effect immediately.